Buprenorphine Maintenance for Opioid Addicted Persons in Jail and Post-Release

描述（由申请人提供）： 海洛因和其他类阿片滥用仍然是刑事司法人员中的一个重大问题。 2002年，刑事司法系统是36%的药物滥用治疗收治的转诊来源，是最大的转诊来源。 罪犯使用海洛因会对健康和社会造成严重后果。 注射仍然是海洛因使用者的主要给药途径，与艾滋病毒、丙型肝炎和其他血液传播疾病的传播密切相关。 在1997年期间，美国20%至26%的艾滋病毒感染者和29%至43%的丙型肝炎感染者通过了教养机构。 海洛因使用与犯罪活动之间的关系已有大量文献记载。 尽管自20世纪70年代以来美沙酮维持一直是慢性阿片类药物依赖的主要治疗方法，但美国的矫正系统，除了极少数例外，没有提供机构获得美沙酮维持治疗的机会。 令人遗憾的是，在刑事司法专业人员、公众、治疗提供者和阿片类药物依赖罪犯本身中，对美沙酮的消极态度普遍存在;这种情况短期内改变的前景很小。 丁丙诺啡维持疗法是最近批准的一种疗法，由于几个原因，它可能比美沙酮更容易被刑事司法系统和阿片类药物依赖者接受。 除了一个微小的例外，丁丙诺啡从未在美国的矫正环境中作为阿片类药物替代疗法系统给药。本探索性/开发性研究的具体目的如下：1.确定在监狱环境中向脱离治疗的阿片类药物依赖罪犯提供丁丙诺啡维持治疗以及在释放后将这些患者过渡到社区中的丁丙诺啡维持治疗的可行性。 2. 进行一项在监狱环境中开始并在社区项目中继续进行的丁丙诺啡维持治疗（N = 50）与美沙酮维持治疗（N =50）的随机临床试验。 3. 确定罪犯在释放后或退出社区治疗后没有报告接受丁丙诺啡或美沙酮社区治疗的原因。 符合条件的囚犯将被随机分配到监狱接受丁丙诺啡或美沙酮维持治疗，并将在释放时被转介到相应的社区治疗。 结果将在出狱后6个月通过图表审查、个人访谈和药物滥用毒理学进行评估。

DESCRIPTION (provided by applicant): Heroin and other opioid abuse continue as a significant problem among the criminal justice population. In 2002, the criminal justice system was the source of referral for 36% of all substance abuse treatment admissions, the largest source of referrals. Heroin use among offenders has serious health and social consequences. Injection, still the primary route of administration among heroin users, is strongly associated with the transmission of HIV, Hepatitis C, and other blood-borne diseases. During 1997, 20% to 26% of all people living with HIV in the United States, and 29% to 43% of all those infected with Hepatitis C, passed through a correctional facility. The relationship between heroin use and criminal activity has been extensively documented. Although methadone maintenance has been the primary treatment for chronic opioid dependence since the 1970's, correctional systems in the U.S., with very few exceptions, have not provided institutional access to methadone maintenance. Regrettably, negative attitudes to methadone are prevalent among criminal just professionals, the public, treatment providers and opioid-dependent offenders themselves; there is little prospect of that changing soon. Buprenorphine maintenance is a recently approved therapy that may be more acceptable for several reasons than methadone to the criminal justice system and opioid-dependent offenders. With one minor exception, buprenorphine has never been systematically administered as an opioid replacement therapy in a correctional setting in the U.S. The specific aims of this exploratory/developmental study are as follows: 1. to determine the feasibility of providing buprenorphine maintenance to out-of-treatment opioid-dependent offenders in a jail setting and of transitioning those patients to buprenorphine maintenance in the community after release. 2. To conduct a randomized clinical trial of buprenorphine maintenance (N = 50) vs. methadone maintenance (N =50) initiated in the jail setting and continuing in community programs. 3. To determine the reasons that offenders fail to report for community-based buprenorphine or methadone treatment after release or drop out of community treatment. Consenting eligible inmates will be randomly assigned to buprenorphine or methadone maintenance in jail and will be referred to a corresponding community treatment at release. Outcomes will be assessed at 6 months after release from jail by chart review, personal interviews and toxicologies for drugs of abuse.